血友病患者:他们是否有天然的抗凝剂?
Armando Tripodi1, Pier Mannuccio Mannucci2, Flora Peyvandi2,3
1Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy. armando.tripod@unimi.it.
Internal and emergency medicine
|July 29, 2023
概括
血友病患者,曾经被认为免受血栓的保护,现在面临增加的静脉血栓塞栓症 (VTE) 风险由于改进的治疗和手术. 需要进行进一步的试验,以评估抗血栓性预防的有效性,以预防手术后的静脉瘤.
科学领域:
- 血液学 血液学 血液学
- 血管医学 血管医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 血友病 (A和B) 是一种X关联疾病,具有较低的VIII或IX因子水平,历史上被认为可以预防血栓形成.
- 现代血友病护理包括使用因子缩剂和新型药物 (如埃米齐祖马布) 的预防,改善预期寿命和静血能力.
- 预期寿命的延长和近乎正常的血液静止使得血友病患者容易受到常见的静脉血栓栓塞 (VTE) 风险因素的影响.
研究的目的:
- 调查在血友病患者 (HP) 中可能需要进行术前抗血栓预防,以预防术后静脉动脉.
- 评估当前的理解和临床数据,关于手术中HP的VTE风险.
主要方法:
- 临床数据和观察性研究对HP骨科后手术中VTE患病率的综述.
- 分析治疗策略,包括因子替代和绕过剂,以及它们对VTE风险的影响.
主要成果:
- 一项对46名接受骨科手术的HP进行的观察性研究显示,术后的症状性VTE患病率与一般人群相似.
- 目前关于HP抗血栓预防的临床数据有限.
结论:
- 经历重大手术的血友病患者,特别是经过加强的静血支持 (因子缩剂/绕道剂),可能受益于VTE风险评估.
- 多中心前性试验至关重要,以确定抗血栓性预防在预防HP的术后静脉瘤的有效性.
- 在等待进一步的证据之前,建议在接受重大手术的HP进行间歇性气动压缩,使用抗出血预防,并补充因子缩剂或绕道剂.
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